This is the first renewal submission of an application for an NICHD Institutional Training Grant in Pediatric Emergency Medicine intended to provide the Department of Pediatrics at Washington University in St. Louis School of Medicine (WUMS) with the funds necessary to recruit and educate qualified physician-scientists. Our long-term objective is to use this funding to promote the career development of young physician scientists who will become future leaders in biomedical research efforts dedicated to improving health outcomes for children with emergency medical conditions. The specific aims of this proposal are to identify potential trainees at the completion of their residency and to provide them with a two-year research experience in the laboratory of a qualified mentor or with a comparably rigorous mentored patient-oriented research experience, protected from clinical and teaching responsibilities. The focus of the research will be on child health issues in pediatric emergency medicine, including high-priority patient-oriented research with emphasis on the relationship between catastrophic illness, emergency care and long-term disabilities. We will also emphasize molecular mechanisms of infection and immunity, and multiple organ dysfunction syndrome (MODS) arising from traumatic or non-traumatic shock states. We will achieve this goal by creating two tracks: (1) patient-oriented research, and (2) the molecular mechanisms of infection, immunity, and MODS. Recent advances in cell, molecular, and developmental biology will be applied to understanding the pathogenesis and treatment of infection, immunity and MODS. Similarly rigorous patient-oriented research methods will be applied to improve outcomes of high-priority emergency medical and surgical diseases, using the full facilities of the WUMS and its Department of Pediatrics. We have in place a structure in which bright, motivated young pediatricians will flourish in a protected environment and will emerge as leaders in this evolving subspecialty of pediatrics. We plan to enroll one new post-doctoral fellow per year for a 5-year period. The proposed duration of training for each fellow is 2 years. The program takes advantage of 25 established investigators who will serve as mentors. The long-term goals will be realized as its trainees contribute to the development of and leadership as pediatric emergency physician-scientists during the next two or more decades.